Provider Demographics
NPI:1720396245
Name:MERRILL, JENNIFER M (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MERRILL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4845
Mailing Address - Country:US
Mailing Address - Phone:509-303-9700
Mailing Address - Fax:509-783-1094
Practice Address - Street 1:1900 FOWLER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4845
Practice Address - Country:US
Practice Address - Phone:509-303-9700
Practice Address - Fax:509-783-1094
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIL60182188124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist